Provider Demographics
NPI:1003877655
Name:UPDYKE, RALPH DENTON JR (PA)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DENTON
Last Name:UPDYKE
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-7041
Mailing Address - Fax:336-718-9622
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7041
Practice Address - Fax:336-718-9622
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500005817OtherRAILROAD MEDICARE
NC1003877655OtherRAILROAD MEDICARE
NC8101560Medicaid
NC2749046CMedicare PIN
NC500005817OtherRAILROAD MEDICARE
NC1003877655OtherRAILROAD MEDICARE
NC2749046AMedicare ID - Type Unspecified